Hungry bone syndrome after parathyroidectomy more easily resolves in peritoneal dialysis (PD) than hemodialysis (HD) patients, according to new study findings published in International Urology and Nephrology.

A team from the First Affiliated Hospital of Nanjing Medical University in China compared 169 HD and 29 PD patients who underwent total parathyroidectomy (PTx) with autotransplantation. Hungry bone syndrome (HBS) developed in a significantly smaller proportion of PD patients than HD patients after surgery (76% vs 93%), corresponding author Changying Xing, MD, PhD, and colleagues reported. The PD group also required significantly shorter intravenous calcium infusion times (52 vs 74 hours), smaller intravenous calcium dosage (74 vs 121 mmol), and less total calcium (503 vs 811 mmol) during hospitalization.

Furthermore, hyperkalemia developed in significantly fewer PD patients during surgery (7% vs 63%) and 3 days afterward (0% vs 33%). Peak serum potassium levels at surgery (3.91 vs 5.16 mmol/L) and 3 days after surgery (4.11 vs 4.74 mmol/L) were significantly lower in the PD than HD group.

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Multivariate regression analysis revealed that PD is an independent influencer of calcium requirement and serum potassium.  Dr Xing and the team suggested that PD better replenishes serum calcium because of longer daily dialysis time. In addition, hypokalemia appears more common in PD patients perhaps due to inadequate potassium intake and lack of potassium in peritoneal dialysate.

“Thus, anesthetists, endocrine surgeons, and nephrologists should be alert to this phenomenon and devoted to reasonable individual perioperative management for PD patients undergoing PTX,” Dr Xing and colleagues concluded.

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Yang G, Ge Y, Zha X, et al. Peritoneal dialysis can alleviate the clinical course of hungry bone syndrome after parathyroidectomy in dialysis patients with secondary hyperparathyroidism. Intl Urol Nephrol 51:535–542. DOI:10.1007/s11255-019-02076-7